Patient Attitudes towards Interns and Medical Students rotating in Dermatology Clinics in Almadinah Almunawwarah Region, Saudi Arabia

Abstract

Objectives

Outpatient clinics are a key element in dermatology health service provision thus making them an excellent place for intern and medical student rotations. However, this requires that patients are willing to interact with these trainees. This study assessed the attitudes of patients towards interns and medical students rotating in dermatology clinics.

Methods

All 112 patients interacting with medical students and interns at dermatology clinics at King Fahad Specialist Hospital in Almadinah Almunawwarah region, Saudi Arabia, from September to November 2009 completed a cross-sectional survey, which assessed their acceptance of these trainees.

Results

Ninety-eight of 112 patient responses were valid. A total of 44 (44.9%) of these 98 patients had a chance to interact with 1–3 medical students or interns during their visit. The majority of the patients preferred the treating physician to be present during history taking by the interns and students. A majority of patients preferred that their physical examination be done by the physician alone (61.2%), whereas others (26.5%) preferred an intern with the physician. Both male and female patients preferred that their health care provider be of the same sex.

Conclusion

The patients in dermatology clinics accept the services of interns and students, while also expecting privacy. Therefore, interns and students should be confident when taking patient histories and performing physical examinations.

Advances in Knowledge

1. This study showed that patients have favorable attitudes toward medical students and teaching processes even in the most conservative cultures in Saudi Arabia.

2. It also highlighted some points which increase patients’ acceptance of medical students: 1. the physician should explain to patients the importance of clinical experience in medical student teaching; 2. health care should be provided by a trainee/physician of the same sex, especially for female patients; 3. the number of students interacting with each patient should be minimised; 4. patient examination should be performed by a physician, with student participation possibly requested from cooperative patients.

Application to patient care

1. Students should have more confidence in dealing with patients when they realise that patients have a favorable attitude towards them; this will make the teaching and health care process go more smoothly.

2. In order to increase patient satisfaction and minimise their rejection by patients, students should avoid examining patients alone without presence of the treating physician.

3. More clinical exposure for students will result in better doctors participating in a positive way in health care.

Outpatient clinics are a key element in dermatology health service provision thus making them an excellent place for intern and medical student learning.1 Thus, medical students who are rotating in dermatology obtain considerable benefit from their learning experience in these clinics. This also gives them more opportunity to interact with patients and their relatives than in any other specialty. A large number of patients in our dermatology clinic are females so they might refuse student participation in their care due to concerns about privacy or because of their conservative cultural background. The latter is especially true in the Almadinah Almunawwarah region location of Al Madinah, the second most important Islamic city in Saudi Arabia.

Interestingly, several investigators have found patient attitudes toward medical students to be favourable in internal medicine and surgery clinics.1,2,3 Similar studies conducted in dermatology clinics inside and outside Saudi Arabia have shown that a large percentage of patients accept the participation of medical students in their care.4,5 Prior information about the presence of a medical students and their specific role during clinical examination was felt to be essential by a significant number of patients.6

However, the patient acceptance of medical students and interns has not been studied in the Almadinah region of Saudi Arabia. This region has a medical college with the medical students undertaking their formal and elective rotations in both King Fahad Specialist Hospital (KFSH) and Auhd Hospital. The objective of this research was therefore to study attitudes of patients toward interns and medical students who rotate in the dermatology clinics in Almadinah region.

Methods

This cross-sectional survey was conducted at KFSH in Almadinah Almunawwarah region in the two month period, September to November 2009. The survey consisted of 15 questions on patient demographic information and preferences regarding medical student participation in providing health services and participating in clinical examination. The questionnaire and study protocol were obtained from a previous study, the authors also providing us with an Arabic translation.1 We then modified the questionnaire to include medical interns, to see if there would be any difference in patient acceptance of students as compared to the interns (see questionnaire in annexe). We tested the questionnaire in a pilot study which included 15 patients. Data were collected by distributing the self-reported questionnaires in consultation rooms in dermatology clinics at KFSH and Auhd Hospital. The questionnaires were distributed to all those patients who were managed by interns and medical students. The respondents were asked to choose the most relevant response. The 112 returned questionnaires, of which 14 were discarded due to incomplete data, were analysed using the Statistical Package for Social Sciences (SPSS) for Windows, Version 17.0 (SPSS Inc., Chicago, IL, USA). A P value of <0.05 was used for statistical significance. Approval for this study was obtained from the Medical College of Taibah University, Saudi Arabia.

Results

Ninety-eight patients from dermatology clinics were included in this study. Their mean age was 24.3 ± 6.2 years; 59% were female and all had received some education with 52.6% having college education or above. During their visit to the dermatology clinics, forty-four patients (44.9%) interacted with 1–3 medical students, while 15.3% interacted with 3–4 students [Table 1].

Table 1.

Demographic data of dermatology clinic patients

	No. (%)
Age (mean ± standard deviation)	24.3 ± 6.2
Female	58 (59.2)
Male	40 (40.8)
Education
Intermediate or less	12 (12.2)
Secondary	31 (31.6)
Technical school	4 (4.1)
College graduate	38 (38.8)
Postgraduate study	13 (13.8)
Number of students seen in previous visit
None	39 (39.8)
1–3	44 (44.9)
4–5	15 (15.3)
>5	0

Regarding patient preferences for intern and medical student participation in outpatient dermatology clinics, 60.2% of respondents preferred to see students with the physician while 21.4% preferred to see the physician alone. Similar figures were obtained for intern participation: 57.1% preferred to see interns with the physician and 23.5% preferred to see the physician alone [Table 2].

Table 2.

Patient preferences in regards to medical students and interns

	Total n (%)	Male n (%)	Female n (%)	P value
Medical student participation	98 (100)	58 (59.2)	40 (40.8)
Physician alone	21 (21.4)	12 (57.1)	9 (42.9)	< 0.016
Student with physician	59 (60.2)	30 (50.8)	29 (49.1)
No preference	18 (18.4)	16 (88.9)	2 (11.1)
Intern participation	98 (100)	58 (59.2)	40 (40.8)
Physician alone	23 (23.5)	9 (39.1)	14 (60.9)	<0.00
Intern with physician	56 (57.1)	30 (53.6)	26 (46.4)
No preference	19 (19.4)	19 (100)	0
Physical examination	98 (100)	58 (59.2)	40 (40.8)
Physician alone	60 (61.2)	38 (63.3)	22 (36.7)
Intern with physician	26 (26.5)	11(42.3)	15 (57.7)	< 0.012
Student with physician	4 (4.1)	1(25)	3 (75)
No preference	8 (8.2)	8 (100)	0

Regarding participation of students in the physical examination, 61.2% of respondents preferred to see the physician alone and 26.5% preferred interns in the presence of the treating physician; only 4.1% preferred to see students with the physician as shown in the Table 2.

Patient responses to a variety of preference questions are listed in Table 3. As shown, 78.6% preferred to see students of the same sex, whereas 21.4% did not mind about the sex of the student. All female patients wanted a same sex health care provider, whereas 63.8% of male patients wanted male students and interns. This difference between males and females was statistically significant (P = 0.00). Of the study participants, 77.5% wanted to discuss their health problems alone with their physician, while 39.7% agreed to disclose personal health information in front of medical students and interns.

Table 3.

Distribution of Patient Preferences towards the medical trainees

	Strongly agree	Agree	Undecided	Disagree	Strongly disagree
1. Prefer same sex	39 (39.8)	38 (38.8)	5 (5.1)	16 (16.3)	0
2. Wanted time alone with physician	54 (55.1)	22 (22.4)	21(21.4)	1(1)	0
3. Will disclose personal info in front of trainees	17 (17.3)	22 (22.4)	34 (34.7)	7 (7.1)	18 (18.4)
4. Enjoyed interacting with trainees	27 (27.6)	39 (39.8)	6 (6.1)	21(21.4)	5 (5.1)
5. Received more attention when trainee present	24 (24.5)	18 (18.4)	42 (42.9)	12 (12.2)	2 (2)
6 Trainees understood my health needs	25 (25.5)	30 (30.6)	24 (24.5)	12 (12.2)	7 (7.1)

The majority of the patients (67.4%) stated that they enjoyed interacting with medical students in outpatient dermatology clinics. Out of those who were involved in the study, 42.9% felt that they got more attention from their physician in the presence of the medical students, and 56.1% felt that the students understood their health needs. The chi-square test showed a statistically insignificant relationship between number of medical students and patient acceptance of them participating in the clinic (P = 0.18). On the other hand, there was a statistically significant relationship between the number of the students and their acceptance by patients during clinical examination (P = 0.00). Also the sex of the patient and that of the care giver was a significant factor during the examination (P = 0.01).

Discussion

The attention given to patient-medical student interaction in medical literature is very much deserved and needs to be sustained.7 Medical student participation in outpatient clinics is an integral component of their medical school education and the patients are often the focal point of the teaching process. Patient’s willingness and comfort level regarding the involvement of a medical trainee in their care may be affected by their previous experience with trainees, their understanding of the role and responsibilities of trainees, and the nature of the medical problem.8

Our study showed that patients had a favorable attitude toward medical student and intern participation in their health care. The majority of patients preferred the presence of the treating physician alongside the trainees, and preferred to undergo physical examination by the physician alone. The attitude toward interns was more favourable compared to medical students. All of the female patients wanted to deal with female students, whereas over 60% of males preferred to deal with male students. Amongst the study participants, 39.7% did not mind disclosing personal information to the students. The majority of patients enjoyed interacting with the students and felt that the students understood their health needs.

Although the results of attitudes of the patients were positive for acceptance of the student participation in the dermatology clinics, the figures were less than those in the study by Townsend et al. which was carried out in the USA.2 This might be due to cultural differences between the two countries as Saudi Arabia has a more conservative culture. It could also be due to the large percentage of female patients (59.2%) in our study.

Based on the results of our study, we would like to suggest some points that might make medical student and intern participation in dermatology clinics easier and more acceptable. The physician should try to explain to the patients the importance of direct interaction with patients in medical student teaching. Health care should also preferably be provided by a trainee/physician of the same sex, especially for the physical examination of female patients. The number of trainees interacting with each patient should be minimised. Examination of patients, especially of the private organs, should be performed by a physician alone, but student/ intern participation in physical examination may be requested from cooperative patients.

Conclusion

In the Al-Madenah Al-Munawwarah region, medical student and intern participation is generally accepted by patients in dermatology clinics and therefore they should be confident during history taking and examination, while making efforts to maintain patient privacy.